Top

BMC Pulmonary Medicine

Published in:

Open Access 01-12-2019 | Central Nervous System Trauma | Research article

The effect of hyperoxia on mortality in critically ill patients: a systematic review and meta analysis

Authors: Yue-Nan Ni, Yan-Mei Wang, Bin-Miao Liang, Zong-An Liang

Published in: BMC Pulmonary Medicine | Issue 1/2019

Abstract

Background

Studies investigating the role of hyperoxia in critically ill patients have reported conflicting results. We did this analysis to reveal the effect of hyperoxia in the patients admitted to the intensive care unit (ICU).

Methods

Electronic databases were searched for all the studies exploring the role of hyperoxia in adult patients admitted to ICU. The primary outcome was mortality. Random-effect model was used for quantitative synthesis of the adjusted odds ratio (aOR).

Results

We identified 24 trials in our final analysis. Statistical heterogeneity was found between hyperoxia and normoxia groups in patients with mechanical ventilation (I² = 92%, P < 0.01), cardiac arrest(I² = 63%, P = 0.01), traumatic brain injury (I² = 85%, P < 0.01) and post cardiac surgery (I² = 80%, P = 0.03). Compared with normoxia, hyperoxia was associated with higher mortality in overall patients (OR 1.22, 95% CI 1.12~1.33), as well as in the subgroups of cardiac arrest (OR 1.30, 95% CI 1.08~1.57) and extracorporeal life support (ELS) (OR 1.44, 95% CI 1.03~2.02).

Conclusions

Hyperoxia would lead to higher mortality in critically ill patients especially in the patients with cardiac arrest and ELS.

Available only for authorised users

Esteban A, Anzueto A, Alía I, Gordo F, Apezteguía C, Pálizas F, Cide D, Goldwaser R, Soto L, Bugedo G, et al. How is mechanical ventilation employed in the intensive care unit? An international utilization review. Am J Respir Crit Care Med. 2000;161(5):1450–8.PubMedCrossRef

Helmerhorst HJ, Schultz MJ, van der Voort PH, Bosman RJ, Juffermans NP, de Wilde RB, van den Akker-van Marle ME, van Bodegom-Vos L, de Vries M, Eslami S, et al. Effectiveness and clinical outcomes of a two-step implementation of conservative oxygenation targets in critically ill patients: a before and after trial. Crit Care Med. 2016;44(3):554–63.PubMedCrossRef

Altemeier WA, Sinclair SE. Hyperoxia in the intensive care unit: why more is not always better. Curr Opin Crit Care. 2007;13(1):73–8.PubMedCrossRef

Sinclair SE, Altemeier WA, Matute-Bello G, Chi EY. Augmented lung injury due to interaction between hyperoxia and mechanical ventilation. Crit Care Med. 2004;32(12):2496–501.PubMedCrossRef

Lodato RF. Decreased O2 consumption and cardiac output during normobaric hyperoxia in conscious dogs. J Appl Physiol (1985). 1989;67(4):1551–9.CrossRef

Farquhar H, Weatherall M, Wijesinghe M, Perrin K, Ranchord A, Simmonds M, Beasley R. Systematic review of studies of the effect of hyperoxia on coronary blood flow. Am Heart J. 2009;158(3):371–7.PubMedCrossRef

Zwemer CF, Whitesall SE, D'Alecy LG. Hypoxic cardiopulmonary-cerebral resuscitation fails to improve neurological outcome following cardiac arrest in dogs. Resuscitation. 1995;29(3):225–36.PubMedCrossRef

Tateda K, Deng JC, Moore TA, Newstead MW, Paine R 3rd, Kobayashi N, Yamaguchi K, Standiford TJ. Hyperoxia mediates acute lung injury and increased lethality in murine legionella pneumonia: the role of apoptosis. J Immunol. 2003;170(8):4209–16.PubMedCrossRef

Bhandari V, Maulik N, Kresch M. Hyperoxia causes an increase in antioxidant enzyme activity in adult and fetal rat type II pneumocytes. Lung. 2000;178(1):53–60.PubMedCrossRef

10.

Barazzone C, White CW. Mechanisms of cell injury and death in hyperoxia: role of cytokines and Bcl-2 family proteins. Am J Respir Cell Mol Biol. 2000;22(5):517–9.PubMedCrossRef

11.

Barazzone C, Horowitz S, Donati YR, Rodriguez I, Piguet PF. Oxygen toxicity in mouse lung: pathways to cell death. Am J Respir Cell Mol Biol. 1998;19(4):573–81.PubMedCrossRef

12.

de Jonge E, Peelen L, Keijzers PJ, Joore H, de Lange D, van der Voort PH, Bosman RJ, de Waal RA, Wesselink R, de Keizer NF. Association between administered oxygen, arterial partial oxygen pressure and mortality in mechanically ventilated intensive care unit patients. Crit Care. 2008;12(6):R156.PubMedPubMedCentralCrossRef

13.

Page D, Ablordeppey E, Wessman BT, Mohr NM, Trzeciak S, Kollef MH, Roberts BW, Fuller BM. Emergency department hyperoxia is associated with increased mortality in mechanically ventilated patients: a cohort study. Crit Care. 2018;22(1):9.PubMedPubMedCentralCrossRef

14.

Elmer J, Scutella M, Pullalarevu R, Wang B, Vaghasia N, Trzeciak S, Rosario-Rivera BL, Guyette FX, Rittenberger JC, Dezfulian C, Pittsburgh Post-Cardiac Arrest Service (PCAS). The association between hyperoxia and patient outcomes after cardiac arrest: analysis of a high-resolution database. Intensive Care Med. 2015;41(1):49–57.PubMedCrossRef

15.

Ihle JF, Bernard S, Bailey MJ, Pilcher DV, Smith K, Scheinkestel CD. Hyperoxia in the intensive care unit and outcome after out-of-hospital ventricular fibrillation cardiac arrest. Crit Care Resusc. 2013;15(3):186–90.PubMed

16.

Asher SR, Curry P, Sharma D, Wang J, O'Keefe GE, Daniel-Johnson J, Vavilala MS. Survival advantage and PaO2 threshold in severe traumatic brain injury. J Neurosurg Anesthesiol. 2013;25(2):168–73.PubMedCrossRef

17.

Davis DP, Meade W, Sise MJ, Kennedy F, Simon F, Tominaga G, Steele J, Coimbra R. Both hypoxemia and extreme hyperoxemia may be detrimental in patients with severe traumatic brain injury. J Neurotrauma. 2009;26(12):2217–23.PubMedCrossRef

18.

Higgins JPT, Green S. Cochrane handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011. Available from www.handbook.cochrane.org.

19.

Eastwood G, Bellomo R, Bailey M, Taori G, Pilcher D, Young P, Beasley R. Arterial oxygen tension and mortality in mechanically ventilated patients. Intensive Care Med. 2012;38(1):91–8.PubMedCrossRef

20.

Bellomo R, Bailey M, Eastwood GM, Nichol A, Pilcher D, Hart GK, Reade MC, Egi M, Cooper DJ, Study of Oxygen in Critical Care (SOCC) Group. Arterial hyperoxia and in-hospital mortality after resuscitation from cardiac arrest. Crit Care. 2011;15(2):R90.PubMedPubMedCentralCrossRef

21.

Helmerhorst HJ, Roos-Blom MJ, van Westerloo DJ, Abu-Hanna A, de Keizer NF, de Jonge E. Associations of arterial carbon dioxide and arterial oxygen concentrations with hospital mortality after resuscitation from cardiac arrest. Crit Care. 2015;19:348.PubMedPubMedCentralCrossRef

22.

Janz DR, Hollenbeck RD, Pollock JS, McPherson JA, Rice TW. Hyperoxia is associated with increased mortality in patients treated with mild therapeutic hypothermia after sudden cardiac arrest. Crit Care Med. 2012;40(12):3135–9.PubMedPubMedCentralCrossRef

23.

Kilgannon JH, Jones AE, Parrillo JE, Dellinger RP, Milcarek B, Hunter K, Shapiro NI, Trzeciak S, Emergency Medicine Shock Research Network (EMShockNet) Investigators. Relationship between supranormal oxygen tension and outcome after resuscitation from cardiac arrest. Circulation. 2011;123(23):2717–22.PubMedCrossRef

24.

Lee BK, Jeung KW, Lee HY, Lee SJ, Jung YH, Lee WK, Heo T, Min YI. Association between mean arterial blood gas tension and outcome in cardiac arrest patients treated with therapeutic hypothermia. Am J Emerg Med. 2014;32(1):55–60.PubMedCrossRef

25.

Brenner M, Stein D, Hu P, Kufera J, Wooford M, Scalea T. Association between early hyperoxia and worse outcomes after traumatic brain injury. Arch Surg. 2012;147(11):1042–6.PubMedCrossRef

26.

Raj R, Bendel S, Reinikainen M, Kivisaari R, Siironen J, Lång M, Skrifvars M. Hyperoxemia and long-term outcome after traumatic brain injury. Crit Care. 2013;17(4):R177.PubMedPubMedCentralCrossRef

27.

Fujita M, Oda Y, Yamashita S, Kaneda K, Kaneko T, Suehiro E, Dohi K, Kuroda Y,Kobata H, Tsuruta R, Maekawa T. Early-stage hyperoxia is associated with favorable neurological outcomes and survival after severe traumatic brain injury: a post-hoc analysis of the brain hypothermia study. J Neurotrauma. 2017;34(8):1565–570.

28.

Rincon F, Kang J, Vibbert M, Urtecho J, Athar MK, Jallo J. Significance of arterial hyperoxia and relationship with case fatality in traumatic brain injury: a multicentre cohort study. J Neurol Neurosurg Psychiatry. 2014;85(7):799–805.PubMedCrossRef

29.

Rincon F, Kang J, Maltenfort M, Vibbert M, Urtecho J, Athar MK, Jallo J, Pineda CC, Tzeng D, McBride W, et al. Association between hyperoxia and mortality after stroke: a multicenter cohort study. Crit Care Med. 2014;42(2):387–96.PubMedCrossRef

30.

Young P, Beasley R, Bailey M, Bellomo R, Eastwood GM, Nichol A, Pilcher DV, Yunos NM, Egi M, Hart GK, et al. The association between early arterial oxygenation and mortality in ventilated patients with acute ischaemic stroke. Crit Care Resusc. 2012;14(1):14–9.PubMed

31.

Lång M, Raj R, Skrifvars MB, Koivisto T, Lehto H, Kivisaari R, von Und Zu Fraunberg M, Reinikainen M, Bendel S. Early moderate Hyperoxemia does not predict outcome after aneurysmal subarachnoid hemorrhage. Neurosurgery. 2016;78(4):540–5.PubMedCrossRef

32.

Sutton AD, Bailey M, Bellomo R, Eastwood GM, Pilcher DV. The association between early arterial oxygenation in the ICU and mortality following cardiac surgery. Anaesth Intensive Care. 2014;42(6):730–5.PubMed

33.

Helmerhorst HJ, Arts DL, Schultz MJ, van der Voort PH, Abu-Hanna A, de Jonge E, van Westerloo DJ. Metrics of arterial Hyperoxia and associated outcomes in critical care. Crit Care Med. 2017;45(2):187–95.PubMedCrossRef

34.

Munshi L, Kiss A, Cypel M, Keshavjee S, Ferguson ND, Fan E. Oxygen thresholds and mortality during extracorporeal life support in adult patients. Crit Care Med. 2017;45(12):1997–2005.PubMedCrossRef

35.

Russell DW, Janz DR, Emerson WL, May AK, Bernard GR, Zhao Z, Koyama T, Ware LB. Early exposure to hyperoxia and mortality in critically ill patients with severe traumatic injuries. BMC Pulm Med. 2017;17(1):29.PubMedPubMedCentralCrossRef

36.

Asfar P, Schortgen F, Boisramé-Helms J, Charpentier J, Guérot E, Megarbane B, Grimaldi D, Grelon F, Anguel N, Lasocki S, et al. Hyperoxia and hypertonic saline in patients with septic shock (HYPERS2S): a two-by-two factorial, multicentre, randomised, clinical trial. Lancet Respir Med. 2017;5(3):180–90.PubMedCrossRef

37.

Zhilyaev SY, Moskvin AN, Platonova TF, Gutsaeva DR, Churilina IV, Demchenko IT. Hyperoxic vasoconstriction in the brain is mediated by inactivation of nitric oxide by superoxide anions. Neurosci Behav Physiol. 2003;33(8):783–7.PubMedCrossRef

38.

Schumann J, Henrich EC, Strobl H, Prondzinsky R, Weiche S, Thiele H, Werdan K, Frantz S, Unverzagt S. Inotropic agents and vasodilator strategies for the treatment of cardiogenic shock or low cardiac output syndrome. Cochrane Database Syst Rev. 2018;1:CD009669.PubMed

39.

De Backer D, Biston P, Devriendt J, Madl C, Chochrad D, Aldecoa C, Brasseur A, Defrance P, Gottignies P, Vincent JL, SOAP II Investigators. Comparison of dopamine and norepinephrine in the treatment of shock. N Engl J Med. 2010;362(9):779–89.PubMedCrossRef

40.

Crapo JD, Hayatdavoudi G, Knapp MJ, Fracica PJ, Wolfe WG, Piantadosi CA. Progressive alveolar septal injury in primates exposed to 60% oxygen for 14 days. Am J Phys. 1994;267(6 Pt 1):L797–806.

41.

Six S, Jaffal K, Ledoux G, Jaillette E, Wallet F, Nseir S. Hyperoxemia as a risk factor for ventilator-associated pneumonia. Crit Care. 2016;20(1):195.PubMedPubMedCentralCrossRef

42.

Kress JP, Hall JB. ICU-acquired weakness and recovery from critical illness. NEngl J Med. 2014;371(3):287–8.CrossRef

43.

Marshall JC, Cook DJ, Christou NV, Bernard GR, Sprung CL, Sibbald WJ. Multiple organ dysfunction score: a reliable descriptor of a complex clinical outcome. Crit Care Med. 1995;23(10):1638–52.PubMedCrossRef

44.

Oddo M, Levine JM, Mackenzie L, Frangos S, Feihl F, Kasner SE, Katsnelson M, Pukenas B, Macmurtrie E, Maloney-Wilensky E, et al. Brain hypoxia is associated with short-term outcome after severe traumatic brain injury independently of intracranial hypertension and low cerebral perfusion pressure. Neurosurgery. 2011;69(5):1037–45 discussion 1045.PubMed

45.

Vespa PM, McArthur D, O'Phelan K, Glenn T, Etchepare M, Kelly D, Bergsneider M, Martin NA, Hovda DA. Persistently low extracellular glucose correlates with poor outcome 6 months after human traumatic brain injury despite a lack of increased lactate: a microdialysis study. J Cereb Blood Flow Metab. 2003;23(7):865–77.PubMedCrossRef

46.

Siggaard-Andersen O, Fogh-Andersen N, Gøthgen IH, Larsen VH. Oxygen status of arterial and mixed venous blood. Crit Care Med. 1995;23(7):1284–93.PubMedCrossRef

47.

Adamides AA, Winter CD, Lewis PM, Cooper DJ, Kossmann T, Rosenfeld JV. Current controversies in the management of patients with severe traumatic brain injury. ANZ J Surg. 2006;76(3):163–74.PubMedCrossRef

48.

Chen HI, Stiefel MF, Oddo M, Milby AH, Maloney-Wilensky E, Frangos S, Levine JM, Kofke WA, LeRoux PD. Detection of cerebral compromise with multimodality monitoring in patients with subarachnoid hemorrhage. Neurosurgery. 2011;69(1):53–63 discussion 63.PubMedCrossRef

49.

Bohman LE, Pisapia JM, Sanborn MR, Frangos S, Lin E, Kumar M, Park S, Kofke WA, Stiefel MF, LeRoux PD, et al. Response of brain oxygen to therapy correlates with long-term outcome after subarachnoid hemorrhage. Neurocrit Care. 2013;19(3):320–8.PubMedCrossRef

50.

Bitterman H. Bench-to-bedside review: oxygen as a drug. Crit Care. 2009;13(1):205.PubMedPubMedCentralCrossRef

51.

Tolias CM, Reinert M, Seiler R, Gilman C, Scharf A, Bullock MR. Normobaric hyperoxia--induced improvement in cerebral metabolism and reduction in intracranial pressure in patients with severe head injury: a prospective historical cohort-matched study. J Neurosurg. 2004;101(3):435–44.PubMedCrossRef

52.

Sackner MA, Landa J, Hirsch J, Zapata A. Pulmonary effects of oxygen breathing. A 6-hour study in normal men. Ann Intern Med. 1975;82(1):40–3.PubMedCrossRef

53.

Kraft F, Andel H, Gamper J, Markstaller K, Ullrich R, Klein KU. Incidence of hyperoxia and related in-hospital mortality in critically ill patients: a retrospective data analysis. Acta Anaesthesiol Scand. 2018;62(3):347–56.PubMedCrossRef

54.

Rea TD, Eisenberg MS, Becker LJ, Murray JA, Hearne T. Temporal trends in sudden cardiac arrest: a 25-year emergency medical services perspective. Circulation. 2003;107(22):2780–5.PubMedCrossRef

55.

Goldberger ZD, Chan PS, Berg RA, Kronick SL, Cooke CR, Lu M, Banerjee M, Hayward RA, Krumholz HM, Nallamothu BK, American Heart Association Get With The Guidelines—Resuscitation (formerly National Registry of Cardiopulmonary Resuscitation) Investigators. Duration of resuscitation efforts and survival after in-hospital cardiac arrest: an observational study. Lancet. 2012;380(9852):1473–81.PubMedPubMedCentralCrossRef

Title: The effect of hyperoxia on mortality in critically ill patients: a systematic review and meta analysis
Authors: Yue-Nan Ni
Yan-Mei Wang
Bin-Miao Liang
Zong-An Liang
Publication date: 01-12-2019
Publisher: BioMed Central
Keywords: Central Nervous System Trauma
Heart Surgery
Heart Surgery
Published in: BMC Pulmonary Medicine / Issue 1/2019
Electronic ISSN: 1471-2466
DOI: https://doi.org/10.1186/s12890-019-0810-1

ACC 2024 Congress Coverage

Heart Failure Video

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

The effect of hyperoxia on mortality in critically ill patients: a systematic review and meta analysis

Abstract

Background

Methods

Results

Conclusions

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2019

Functional variations of the TLR4 gene in association with chronic obstructive pulmonary disease and pulmonary tuberculosis

Diagnostic yield and risk/benefit analysis of trans-bronchial lung cryobiopsy in diffuse parenchymal lung diseases: a large cohort of 699 patients

Prognostic values of the Berlin definition criteria, blood lactate level, and fibroproliferative changes on high-resolution computed tomography in ARDS patients

Risk of transmission via medical employees and importance of routine infection-prevention policy in a nosocomial outbreak of Middle East respiratory syndrome (MERS): a descriptive analysis from a tertiary care hospital in South Korea

Diagnoses from lung specimen collected through flexible bronchoscopy from patients in a tertiary hospital in Dar es Salaam Tanzania: a retrospective cross-sectional study

Severe exacerbations in moderate-to-severe asthmatics are associated with increased pro-inflammatory and type 1 mediators in sputum and serum

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page